JHI Partners Forum, 2012
Linda A. Lee, MD
Johns Hopkins Integrative Medicine & Digestive Center
Division of Gastroenterology and Hepatology
Primary location at Green Spring Station
 Consultative services also available at the Hospital
 Staff

 Four physicians (internist, GYN, GI, rheumatologist)
 Two acupuncturists (TCM)
 Four licensed massage therapists
 Two psychotherapists – hypnotherapy, CBT, guided imagery
 One nutritionist – individual consultations and group classes

To create an inviting, comfortable, safe
environment

Allow lengthy appointments so there is more
time to understand the multiple dimensions of
illness, to educate the patient, and discuss the
full range of evidence-based therapies

Offer services within the Center that would be
readily accessible to patients as well as referring
providers

4000 visits to the Center in FY12

Open Mon-Sat, evening hours until 9 pm

6 examination rooms, all multipurpose

Staff offer personal, concierge-type service

Is the only integrative medicine center in the
US based in gastroenterology
www.hopkinsintegrative.org

What training or education did she receive?

Is the practitioner licensed in the state?

Is certification by a professional organization
required for state licensure? (e.g. NCCAOM)

What clinical and research experience does she
have?

Is the practitioner integrative, or disintegrative?

Engage the patient as an active participant

Provide education about health, symptoms, and
diseases

Counsel in appropriate nutrition practices and
supplement use

Discuss evidence-based pharmacologic and mindbody therapies

The patient-provider interaction is a vital part of the
healing process
Medical therapy
 Additional testing
 Lifestyle changes

 Low fat diet
 Avoid caffeine
 Avoid carbonated
beverages
 Limit your alcohol intake
 Stop smoking
 Raise the head of your
bed

Esophageal hypersensitivity has been implicated as a
cause of reflux symptoms

Psychosocial factors are known to mediate both
peripheral and central hypersensitivity and play a role in
symptom perception among patients with GERD

Behavioral medicine techniques (CBT and
hypnotherapy) may be a useful adjunct to other antireflux therapy in those who experience increased
symptoms during stress
McDonald-Haile, J, et al. Gastroenterology, 1994;107(1):61-9
Van Peski-Oosterbaan, AS, et al. Am J Med 1999; 106: 424–9
Miwa, H et al. J Neurogastroenterol Motil, Vol. 16 No. 4 October, 2010



Medical therapy
Additional testing
Lifestyle changes






Low fat diet
Avoid caffeine
Avoid carbonated beverages
Limit your alcohol intake
Stop smoking
Raise the head of your bed

PLUS
THIS:





Understand and treat the
symptoms in the context of the
patient’s home and work life
Educate the patient as to why
GERD occurs
Discuss weight loss as a longterm management strategy
Discuss evidence-based
acupuncture
Answer questions about the use
of supplements
Determine if stress is a trigger
for symptoms and identify
strategies for addressing stress
Dickman, R. et al. Aliment Pharmacol Ther 2007. 26: 1333–1344
Fennel seed
no scientific evidence… yet
Licorice
Apple Cider Vinegar
Conventional care
Physician
Physician
Acupuncturist
JHIMDC
Nutritionist
Psychotherapist
Massage Therapist

Cost savings could be realized by
 Decreasing utilization of expensive medical
interventions such as pharmaceuticals, or
reducing trips to the ER
 Reducing provider visits by offering group
interventions, such as stress reduction, nutrition
education, and mind-body skills training

By the year 2022, 80% of the US population
will be overweight or obese (currently 66%)

Projected healthcare spending related to
overweight and obesity by the year 2020 is
estimated to be $437.6 billion (was $81.5
billion in 2000)
Yang, F. et al Obesity (2008) 16 10, 2323–2330

Current healthcare reimbursement favors procedures
and pharmaceuticals over education, adequate faceto-face time, mind-body therapies

Conventional practitioners lack knowledge about
evidence-based healing practices and practitioners,
and how to identify them